Provider Demographics
NPI:1932686102
Name:WEST, GWENDYLON (BSW, MSW, QMHP,QIDP)
Entity Type:Individual
Prefix:
First Name:GWENDYLON
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:BSW, MSW, QMHP,QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15053
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-0053
Mailing Address - Country:US
Mailing Address - Phone:313-377-0894
Mailing Address - Fax:
Practice Address - Street 1:882 OAKMAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-4019
Practice Address - Country:US
Practice Address - Phone:313-961-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker